More students than ever are graduating with degrees in public health, but in an alarming trend, relatively few are choosing to pursue careers in the local, governmental public health departments that are the backbone of the nation’s public health infrastructure. Between 2015 and 2020, for example, only 10% of people graduating with undergraduate degrees in public health opted for careers in government, while only 19% of those with graduate degrees joined government agencies between 2015 and 2018.

A new study from the University of Minnesota School of Public Health (SPH) explores this troubling trend, and offers recommendations for how to fix it. Where previous studies have examined discrete elements of public health workforce issues—analyzing how to increase the supply of potential workers, examining recruitment efforts, and looking at retention rates—this is the first study to explore the entire career lifecycle of public health employees.

“Previous research has looked at issues like recruitment and retention of the public health workforce as isolated challenges, but we wanted to look at the overall career journey of people in the workforce,” said Chelsey Kirkland, SPH researcher and lead author. “By examining the entire lifecycle, from how students first learn about public health to how employees are supported and retained, we can identify where the system breaks down and design more effective, lasting solutions to fix it.”

To conduct the study, researchers held interviews and focus groups with participants from 35 local health departments and 23 schools, including students, career counselors, new employees, and agency representatives. Using this data, Kirkland and the research team identified common challenges and opportunities across five stages of the public health career lifecycle, including student perceptions, internships, recruitment, onboarding, and retention.

The study, published in the Journal of Public Health Management and Practice and accompanying blog post in the Wide World of Public Health Systems, identified several challenges in the career lifecycle of the public health workforce, including:

• Confusion around the definition of public health. Students and career counselors sometimes define public health broadly or in different ways, blurring the lines between health care and population health and creating confusion for new or prospective employees.
• Barriers in the student-to-internship pathway. Many local health departments rely on interns but lack funding, structure, or regular pathways to hire them full time. Many interns also have to go through the same cumbersome, complex hiring process as other applicants, creating barriers to their employment.
• Onboarding and retention challenges. Ineffective orientation processes, low pay, and unclear career ladders contributed to high turnover among employees.

To address these challenges, the study includes a number of recommendations, including:

• Strengthening partnerships between schools and local health departments to expose students to public health careers early.
• Expanding and standardizing paid internships and fellowships that directly lead to employment
• Developing robust, consistent onboarding processes.
• Offering better compensation and support to retain staff.

“A strong public health workforce is essential to keeping communities healthy and prepared for future crises,” said Kirkland. “At a time when we need an estimated 80,000 new employees just to meet the nation’s basic public health needs, we have to rethink the entire student-to-employee pipeline, building stronger connections between education, experience, and employment that will encourage more people to enter the field and put us on the path to rebuild the workforce.”